Are Eligible Patients Forced to Use Medicaid?

Below is a copy of a letter to the Administrator of Medicaid, Marilyn Tavenner,  from Dr. Jane M. Orient, MD – Executive Director of

via Are Eligible Patients Forced to Use Medicaid?.

February 18, 2014

Marilyn Tavenner, Administrator

Centers for Medicare and Medicaid Services

1500 Security Boulevard

Baltimore, Maryland 21244

Dear Ms. Tavenner:

On behalf of our members and our patients, I am seeking the answers to several questions that have come up with regard to patients being enrolled in Medicaid through the healthcare Exchanges.

First, is it possible for a patient who is enrolled in Medicaid through the Exchange to disenroll? If so, what is the procedure for doing so?

Second, if the person is enrolled in Medicaid, is he or she given a disclosure about potential estate recovery? As you know, as a consequence of the Affordable Care Act, enrollment in Medicaid may now be contingent only upon income, not assets, so many of the people who are being enrolled have assets that potentially could be seized upon their death. If disclosure is made, are the provisions guaranteed to apply at the time of the person’s death, or could these be changed by state law at some future time?

Third, if a person is enrolled in Medicaid, does he or she have the option of simply not using these benefits and seeking private care? If the patient does choose to pay a physician or facility privately, is the physician or facility potentially subject to fine or prosecution because of accepting the payment?

Many Americans do not wish to be dependent upon the Medicaid program for their medical care. This may be because they would prefer to provide for their own needs rather than being dependent upon the government. Increasingly, it will be because patients are unable to obtain timely or high quality care because of the bureaucratic restraints and price controls that govern Medicaid.

We would appreciate a prompt and specific answer to these questions so that we may make the agency’s official position known to physicians and patients.

Sincerely yours,

Jane M. Orient, M.D.

Executive Director